J Korean Med Sci.  2015 May;30(5):591-597. 10.3346/jkms.2015.30.5.591.

Radiological Findings and Outcomes of Bronchial Artery Embolization in Cryptogenic Hemoptysis

• Kervancioglu S
• Bayram N
• Gelebek Yilmaz F
• Sanli M
• Sirikci A

• KMID: 2155472
• DOI: http://doi.org/10.3346/jkms.2015.30.5.591

Abstract

Management of cryptogenic massive hemoptysis is difficult, and conservative treatment may be inadequate to stop the hemorrhage. Surgery is not a reasonable option because there is no underlying identifiable pathology. This study aimed to investigate the radiologic findings and bronchial artery embolization outcomes in cryptogenic hemoptysis, and to compare the results with non-cryptogenic hemoptysis. We evaluated 26 patients with cryptogenic hemoptysis and 152 patients with non-cryptogenic hemoptysis. A comparison of the bronchial artery abnormalities between the cryptogenic and non-cryptogenic hemoptysis groups showed that only extravasation was more statistically significant in the cryptogenic hemoptysis group than in the non-cryptogenic hemoptysis group, while the other bronchial artery abnormalities, such as bronchial artery dilatation, hypervascularity, and bronchial-to-pulmonary shunting, showed no significant difference between groups. Involvement of the non-bronchial systemic artery was significantly greater in the non-cryptogenic hemoptysis group than in the cryptogenic hemoptysis group. While 69.2% of patients with cryptogenic hemoptysis also had hypervascularity in the contralateral bronchial arteries and/or ipsilateral bronchial artery branches other than the bleeding lobar branches, this finding was not detected in non-cryptogenic hemoptysis. Embolization was performed on all patients using polyvinyl alcohol particles of 355-500 microm. Hemoptysis ceased in all patients immediately after embolization. While recurrence of hemoptysis showed no statistically significant difference between the cryptogenic and non-cryptogenic hemoptysis groups, it was mild in cryptogenic hemoptysis in contrast to mostly severe in non-cryptogenic hemoptysis. Transarterial embolization is a safe and effective technique to manage cryptogenic hemoptysis.

Keyword

Cryptogenic Hemoptysis; Computed Tomography; Angiography; Embolization

MeSH Terms

Adult
Bronchial Arteries/physiopathology/*radiography
Bronchography
Case-Control Studies
*Embolization, Therapeutic
Female
Hemoptysis/radiography/*therapy
Hemorrhage/etiology
Humans
Male
Middle Aged
Recurrence
Tomography, X-Ray Computed

Figure

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  Fig. 1 Axial CT scan (A) Before BAE, demonstrates mass image at paramediastinal area of right upper lobe. (B) 4 days after BAE, demonstrates mass image disappearance.

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  Fig. 2 Images of a patient by CT scan and angiography. (A) Axial CT scan obtained with parenchymal lung window demonstrates hazy consolidation at left upper lobe. (B) Left second intercostal arteriography demonstrates dilatation and hypervascularity. (C) Bronchial arteriography shows combined right and left bronchial trunk with hypervascularity, more prominent in the left upper lobe. (D) CT scan obtained 10 months after embolization demonstrates normal lung parenchyma.

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  Fig. 3 In a patient with right upper lobe hemorrhage, arteriography of right intercostal bronchial trunk demonstrates dilatation of right bronchial artery with hypervascularity in all, more prominent upper lobe.

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  Fig. 4 In a patient with left lower lobe hemorrhage, arteriography of combined right and left bronchial trunk demonstrates mild dilatation of right bronchial artery with hypervascularity in all, more prominent upper lobe, and thin left bronchial artery with extravasation of the contrast material into the lower lobe bronchial lumen (arrow).

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